US7998203B2

US7998203B2 - Total knee prosthesis and method for total knee arthroplasty

Info

Publication number: US7998203B2
Application number: US12/134,713
Authority: US
Inventors: Michael F. Blum
Original assignee: Individual
Current assignee: Individual
Priority date: 2008-06-06
Filing date: 2008-06-06
Publication date: 2011-08-16
Also published as: WO2009148689A1; US9855062B2; US20090306784A1; US20090306783A1

Abstract

A prosthetic knee implant for implantation into a mammal, which accommodates an anterior cruciate ligament substitute to provide stability to the knee implant. The prosthetic knee implant includes a femoral component having a pair of condylar surfaces and a tibial component having a surface portion adapted to slidably engage the femoral component upon rotation of the same. The femoral component further includes a recess between the condyles defining an aperture through the femoral component. The tibial component further includes a center portion defining an aperture through the tibial component substantially at its center. The femoral aperture and the tibial aperture are adapted to receive an anterior cruciate ligament substitute for biasing the mammalian femur and tibia together. Also disclosed is a method used to replace the total knee joint in a mammal with the improved prosthetic knee implant of the present invention.

Description

FIELD OF THE INVENTION

The present invention relates generally to prosthetic knee implants and corresponding surgical methods used to replace the total knee joint in a mammal. More particularly, the invention relates to a prosthetic knee implant having a femoral component and a tibial component, which are adapted to receive an anterior cruciate ligament substitute for biasing the femur and tibia together.

BACKGROUND OF THE INVENTION

Mammalian knees wear out for a variety of reasons, including inflammation from arthritis, injury, or simple wear and tear. Over the past 40 years, total knee arthroplasties (commonly referred to as total knee replacements or “TKR”) have become the standard of care for end-stage arthritis. In most TKR procedures, the natural bearing surfaces of the upper portion of the tibia (tibial plateau) and the lower portion of the femur (femoral condyles) are resected and replaced with artificial material. Specifically, approximately between 0.5 to 1.5 centimeters of the upper portion of the tibia, including both the intercondylar eminence and the medial and lateral tibial plateaus, are resected, leaving a relatively flat surface onto which a rigid support member is affixed. Then, a synthetic surface portion is affixed to the support member, with the surface portion simulating the intercondylar eminence and the tibial plateaus. A lower end portion of the femur is then resected, and a member having bearing surfaces replicating the femoral condyles is then affixed to the remaining end of the femur.

The majority of currently available prosthetic knee implants employed for TKR do not retain the natural anterior cruciate ligament. Rather, during the implant procedure, the anterior cruciate ligament is either removed or, if preservation is attempted, has been found to rupture shortly after implant of the prosthesis. This is particularly true for TSR candidates, who often have a sacrificed anterior cruciate ligament going into the surgery. As a result, the mechanical interaction between the femoral and tibial components in a TKR is the primary means to stabilize the anterior-posterior motion of the knee.

Although the existing TKR prostheses succeed in increasing patient mobility, and provide the patient with the desired therapeutic result, at least one significant disadvantage remains. Namely, in a TKR wherein the anterior cruciate ligament is lacking, the femoral condyles translate in a posterior direction in full extension and translate in an anterior direction in flexion, which is reverse of the motions in a natural knee joint. Such abnormal translation and pivot shift often results in the patient's compromised functional abilities, such as quadriceps avoidance, and changed upper body mechanics during activities such as stair climbing and rising from a chair. Even asymptomatic patients show gait abnormalities that could lead to reduced functional ability to perform activities of daily living over time.

Further, abnormal anterior translation of the TKR can lead to accelerated wear of the prosthesis. Indeed, current TKR prostheses have a functional lifespan of approximately 15 years, such that younger patients (who are increasingly receiving TKRs) are more likely to require revision surgery as they age. The amount of bone loss that is inherent in a TKR makes a revision procedure much more difficult in the future as even more bone must be removed.

Existing TKR prostheses attempt to compensate for the loss of the anterior cruciate ligament by containing or limiting the amount of abnormal translation in the nonstabilized knee. For example, U.S. Pat. No. 5,413,604 discloses a TKR prosthesis wherein the anterior cruciate ligament must be sacrificed, thereby resulting in a nonstabilized TKR with abnormal anterior translation. Without an anterior cruciate ligament, the prosthesis relies primarily on the mechanical interaction between the femoral and tibial components as a means to accommodate the abnormal anterior translation and stabilize the knee. Similarly, U.S. Pat. No. 7,014,660 discloses a TKR prosthesis that incorporates a control arm and stop pin assembly to limit the amount of anterior sliding movement caused by the lack of the anterior cruciate ligament. Unfortunately, neither prosthesis disclosed in the '604 and '660 patents actually prevents the abnormal anterior translation of the nonstabilized TKR; rather, they only attempt to accommodate or limit it. As a result, the patient's functional abilities remain limited, and the prosthesis is subject to premature wear and tear. The U.S. Pat. Nos. 5,413,604 and 7,014,660 are hereby incorporated by reference in their entireties.

Therefore, there exists a constant need in this art for an improved TKR prosthesis that allows for the replacement of an anterior cruciate ligament, and approaches the mobility, stability and longevity of a natural, healthy knee joint.

SUMMARY OF THE INVENTION

The present invention is directed to a prosthetic knee implant, and more particularly, to a prosthetic knee implant having a femoral component including a medial and lateral condyle, and a tibial component including a surface portion adapted to slidably engage the femoral component upon rotation of the same. The femoral component includes a recess between the medial and lateral condyles defining an aperture through the femoral component. The tibial component includes a center portion defining an aperture through the tibial component substantially at its center. The femoral aperture and the tibial aperture are adapted to receive an anterior cruciate ligament substitute for biasing the femur and the tibia together.

In addition, a method of total knee joint replacement in a mammal is presented consisting of replacing at least a portion of the lower femur with the improved prosthetic femoral component; replacing at least a portion of the upper tibia with the improved prosthetic tibial component; engaging a drill alignment guide to the femoral component between the femoral condyles and drilling a longitudinal channel through the femoral aperture and into the femur; engaging a drill alignment guide to the tibial component and extending the tibial aperture by drilling a longitudinal channel through the tibia aperture and into the tibia. The method further includes threading an anterior cruciate ligament substitute into the femoral channel and into the tibial channel and anchoring a first end of the ligament substitute to bone leaving a free end; applying tension to the free end; and, anchoring the free end to bone under tension such that said femur and the tibia are biased together.

BRIEF DESCRIPTION OF THE DRAWINGS

A total knee prosthesis apparatus and a method for total knee replacement incorporating the features of the invention are depicted in the attached drawings which form a portion of the disclosure and wherein:

FIG. 1 is an anatomical view of a human knee joint having an anterior cruciate ligament and posterior cruciate ligament;

FIG. 2 is a diagram of a prosthetic knee implant in accordance with a preferred embodiment of the present invention, and implanted at the joint between a human femur and tibia to provide a total knee replacement;

FIG. 3 is a perspective view of the prosthetic knee implant of FIG. 2;

FIG. 4 is an exploded perspective view of the tibial component;

FIG. 5 is a partial exploded view of the femoral component;

FIG. 6A is an illustration of the femur of FIG. 2 having the femoral channel drilled longitudinally through the femoral aperture and into the femur;

FIG. 6B is an illustration of the femur of FIG. 2 with an aligned drill guide for drilling longitudinally through the femoral aperture and into the femur.

FIG. 7 is an illustration of the tibia of FIG. 2 having the tibial channel drilled longitudinally through the tibial aperture and into the tibia;

FIG. 8 is a combined illustration of FIG. 6A and FIG. 7, further depicting the femoral channel and tibial channel in substantial alignment in accordance with a preferred embodiment of the present invention;

FIG. 9 illustrates the anterior cruciate ligament substitute with a self-anchoring umbrella-type anchor being threaded downward through the femoral channel and tibial channel; and

FIG. 10 illustrates the anterior cruciate ligament substitute threaded through the femoral and tibial channels, under tension, and anchored to the exterior surfaces of the femur and tibia with umbrella-type anchors.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to the drawings for a better understanding of the function and structure of the invention, FIG. 1 shows a typical patient's natural knee joint 10 prior to the surgical procedure. Illustrated is upper portion 23 of the tibia 20 the upper portion 26 of the fibula 25, the lower portion 18 of the femur 15, the exterior surface 19 of the femur 15, as well as the medial condyle 16 and lateral condyle 17. The anterior cruciate ligament I1 and the posterior cruciate ligament 14 are seen to be present in the knee joint 10. One end 12 of the anterior cruciate ligament 11 is attached to the anterior portion of the intercondylar eminence 21 of the tibia 20, and the second end 13 of the anterior cruciate ligament 11 is attached to the posterior portion of the medial aspect of the lateral femoral condyle 17, thereby defining an axis 33 of the anterior cruciate ligament 11. The posterior cruciate ligament 14 passes upward and forward on the medial side of the anterior cruciate ligament 11, extending from behind the intercondylar eminence 21 to the lateral side of the medial condyle 16 of the femur 15. Also seen is the exterior surface 22 of the tibia 20, the tibial plateau 24, the medial meniscal cartilage 27 and lateral meniscal cartilage 28.

The femur 15 and tibia 20 extend along a mechanical axis 32 which is generally parallel to the tibia 20 and passes through the head 30 of the natural hip joint (not shown). The tibia 20 rotates about an axis 31 relative to the lower portion 18 of the femur 15 that bisects the

condyles

16 and 17 and is generally perpendicular to the mechanical axis 32. Axis 31 corresponds with what is referred to in the medical industry as the “knee joint line,” this joint line being separated into a medial joint line portion which is the portion of the joint line starting at the intersection of the axis 32 and axis 31 and extending to the right (i.e. in the medial direction) of the knee joint, and a lateral joint line which is the portion of the line starting at the intersection of the axis 32 and axis 31 and extending to the left (i.e. in the lateral direction) of the knee joint. During articulation of the knee joint 10 between flexion and extension, the medial condyle 16 engages the tibia 20 along a medial bearing surface bordered by the medial meniscal cartilage 27, while the lateral condyle 17 engages the tibia 20 along a lateral bearing surface bordered by the lateral meniscal cartilage 28. The anterior crucial ligament 11 limits forward movement of the tibia 20 under the

femoral condyles

16 and 17, while the posterior cruciate ligament 14 limits backward movement of the tibia 20 under the

femoral condyles

16 and 17.

Referring now to FIG. 2, the natural knee joint 10 has been replaced by a prosthetic knee implant 40 constructed in accordance with a preferred embodiment of the present invention. The prosthetic knee implant 40 includes a femoral component 41 affixed to the lower portion 18 of the femur 15 and a tibial component 60 affixed to the upper portion 23 of the tibia 20. The femoral component 41 includes a tibial axis of rotation 49 relative to the lower portion 18 of the femur 15 that is generally perpendicular to the mechanical axis 32 and is also oriented in substantial similarity to axis 31 of FIG. 1.

Referring to FIGS. 3 and 4, the femoral component 41 includes a replacement medial condyle 42 and a replacement lateral condyle 43 of the femur 15. Normally, the ends of the

femoral condyles

16 and 17 are resected and shaped to receive the femoral component 41 and affixed to the femur 15 as is known in the art, such as adhesion using bone cement and/or pegs extending into the

condyles

16 and 17.

The tibial component 60 includes a surface portion 61 adapted to slidably engage the femoral component 41 upon rotation of the tibia 20 about tibial axis 49, in such a manner as to enable the prosthetic knee implant 40 to serve as a substitute for the natural knee joint 10 for relative motion of the femur 15 and tibia 20 between flexion and extension. In a preferred embodiment, the tibial component 60 provides replacement bearing surfaces in the form of lateral bearing surface 69 for engagement by the lateral condyle 43 and medial bearing surface 70 for engagement by the medial condyle 42 of the prosthetic knee implant 40. The tibial component 60 further includes a center portion 62 that defines an aperture 63 through the tibial component 60 substantially at its center. Preferably, the tibial aperture 63 is of sufficient size to accommodate a replacement anterior cruciate ligament.

Typically, the natural anterior cruciate ligament 11 is removed, along with approximately between 0.5 to 1.5 centimeters of the upper portion 23 of the tibia 20, including the tibial plateau 24, the intercondylar eminence 21, the medial meniscal cartilage 27, and the lateral meniscal cartilage 28, thereby leaving a relatively flat surface onto which the tibial component 60 is affixed. In a preferred embodiment, the tibial component 60 includes a support member in the form of a platform 71 having a unitary depending stem 72 inserted into the tibia 20 to assist in the accurate location and affixation of the platform 71 on the tibia 20. In a preferred embodiment, a surface portion 61 is secured in place on platform 71 to be interposed between the femoral component 41 and platform 71 for providing medial and lateral bearing surfaces 70 and 69 and for engagement by the medial condyle 42 and the lateral condyle 43, respectively, to enable articulation of the prosthetic knee implant 40. The

condyles

42 and 43 preferably are constructed of a biocompatible high-strength alloy, while the preferred material for the surface portion 61 is a synthetic polymeric material, such as high-density polyethylene. Surface portion 61 may be secured in place on platform 71 by means of any of several securing arrangements as described in greater detail in U.S. Pat. No. 5,413,604.

In effecting implant of the prosthetic implant 40, the anterior cruciate ligament 11 of the natural knee has been sacrificed. Thus, during articulation of the prosthetic implant 40 between flexion and extension the

condyles

42 and 43 translate in a posterior direction in full extension and translate in an anterior direction in flexion, as described in greater detail in U.S. Pat. No. 5,413,604, col. 4, lines 41-67.

Referring to FIG. 5, the femoral component 41 includes a recess 45 between the medial and

lateral condyles

42 and 43, which defines an aperture 44 through the femoral component 41. Preferably, the femoral aperture 44 is of sufficient size to accommodate an anterior cruciate ligament substitute.

Referring to FIG. 6A, a longitudinal channel 46 is drilled in a conventional manner through the femoral aperture 44 and into the femur 15. In a preferred embodiment, the femoral channel 46 has lower opening 47 and upper opening 48. Alternatively, femoral channel 46 does not extend through the exterior surface 19 of the femur 15 but terminates within the femur 15 bone. The femoral channel 46 is drilled using a conventional two-step process with the engagement of a drill guide (depicted in FIG. 6B) to the femoral component 41 between the

femoral condyles

42 and 43, followed by a drill 50 to create the femoral channel 46 of sufficient size to accommodate an anterior cruciate replacement. In a preferred embodiment, the drill guide (depicted in FIG. 6B) is configured to align the femoral channel 46 with the femoral aperture 44. The femoral channel 46 is typically debrided of all surrounding debris at upper opening 48, and any sharp edges are chamfered using a conventional bone rasp.

Referring to FIG. 6B, there is shown a drill guide 51 engaged with the femoral component 41 to provide a temporary guide for the drill 50 while drilling the femoral channel 46. In a preferred embodiment, the guide 51 includes a first sleeve 52 and a second sleeve 53 aligned longitudinally along a drilling axis 54. The first sleeve 52 and second sleeve 53 each include an

aperture

55 and 56 disposed longitudinally along the drilling axis 54 suitable for allowing the passage of a drill bit 50. The second sleeve 53 is adapted to nest in and mate with the femoral component aperture 44 along the drilling axis 54.

Referring to FIG. 7, a longitudinal channel 64 is drilled in a conventional manner into the tibia 20 and through the tibial aperture 63. In a preferred embodiment, the tibial channel 64 has lower opening 65 and upper opening 66. Alternatively, tibial channel 64 does not extend through the exterior surface 22 of the tibia 20 but terminates within the tibia 20 bone. The tibial channel 64 is drilled using a conventional two-step process with the engagement of a drill guide 51 (FIG. 6B) to the tibial component 60, followed by a subsequent drill 50 to create the tibial channel 64 of sufficient size to accommodate an anterior cruciate ligament substitute. The tibial channel 64 is typically debrided of all surrounding debris at lower opening 65, and any sharp edges are chamfered using a conventional bone rasp. In a preferred embodiment, the surface portion 61 is affixed to platform 71 after the drilling of the tibial channel 64 to prevent damage to the surface portion 61 during drilling. Preferably, the tibial channel 64 and the femoral channel 46 are in alignment and are oriented along an axis generally parallel to the axis 33 of an anatomic anterior cruciate ligament 11.

As mentioned above, the drill guide 51 (FIG. 6B) may also be engaged with the tibial component 60 to facilitate drilling of the tibial channel 64. Specifically, the second sleeve 53 may be adapted to nest in and mate with the tibial aperture 63 to define a drilling axis for the drill 50 while drilling the tibial channel 64. The tibial channel 64 may be drilled from the lower opening 65 to the upper opening 66, or vice versa.

Referring to FIG. 8, there is shown a prosthetic knee implant 40 constructed in accordance with a preferred embodiment. The femoral channel 46 extends through the exterior surface 19 of the femur 15 having lower opening 47 and upper opening 48. The tibial channel 64 extends through the exterior surface 22 of the tibia 20 having lower opening 65 and upper opening 66. Femoral channel 46 and tibial channel 64 are preferably in alignment and oriented along an axis 67 generally parallel to the axis 33 of a natural anterior cruciate ligament 11. The prosthetic implant 40 is now ready to have an anterior cruciate ligament substitute implanted.

The types of anterior cruciate ligament substitutes that can be used in the present invention include allografts, autografts, xenografts and synthetic grafts. Allografis include ligamentous tissue harvested from cadavers and appropriately treated, disinfected, and sterilized. Autografts consist of the patients own ligamentous tissue harvested either from the patellar tendon or from the hamstring. Xenografts include ligamentous tissue harvested from one mammalian species and transplanted into or grafted onto another species, genus, or family (such as from porcupine to a human). Synthetic grafts include grafts made from synthetic polymers such as polyurethane, polyethylene, polyester and other conventional biocompatible, bioabsorbable or nonabsorbable polymers and composites.

Referring to FIG. 9, an anterior cruciate ligament substitute 80 is threaded down into the femoral channel 46 and the tibial channel 64. There are numerous methods and instruments known in the art that may be utilized to thread the anterior cruciate ligament substitute 80, which include the use of a suture passer (such as those disclosed in U.S. Pat. Nos. 5,746,754; 5,439,467; and 5,462,562), a graft-passing wire (such as that disclosed in U.S. Pat. No. 6,623,524), or a ligature carrier (such as that disclosed in U.S. Pat. No. 6,245,073 col. 2 lines 23-25) U.S. Pat. Nos. 5,746,754; 5,439,467; 5,462,562; 6,623,524; and 6,245,073 are hereby incorporated by reference in their entirety. Alternatively, the second end 82 of the ligament substitute 80 is passed down into the upper opening 48 of the femoral channel 46 until it exits the lower opening 47 of the femoral channel 46. A threading instrument 95 having a proximal handle 96 and a distal notched end 97 for engaging the ligament substitute 80 or a leading guide wire 83 attached to the ligament substitute 80 is provided. The distal end 97 of the threading instrument 95 is inserted into the lower opening 65 of the tibial channel 64 and is moved forward and out of the upper opening 66 of the tibial channel 64. Once the ligament substitute 80 is engaged in the distal notched end 97, the threading instrument 95 is withdrawn from the tibial channel 64, thereby pulling the guide wire 83 and passing the second end 82 of the ligament substitute 80 down through the upper opening 66 of the tibial channel 64 and out the lower opening 65 of the tibial channel 64. At that time, the guide wire 83 is removed from the threading instrument 95. The first end 81 of the ligament substitute 80 is anchored to the femur 15 using a conventional securing device such as cross-pins, femoral fasteners, endobuttons, screws, or staples. In a preferred embodiment, the first end 81 of the ligament substitute 80 is anchored to the exterior surface 19 of the femur 15 at the medial aspect of the posterior lateral femoral condyle with a self-anchoring umbrella anchor 90, as shown. Ideally, the ligament substitute 80 is coated with a substance that facilitates bone ingrowth into the ligament substitute 80, such as a hydroxyaptite (HA) coating. Then, the second end 82 of the ligament substitute 80 is placed in tension by the surgeon while the second end 82 is anchored to the bone of the tibia 20, thereby biasing the tibia 20 and femur 15 together. The second end 82 of the ligament substitute 80 may be anchored to the tibia 20 at the tibial anterior medial plateau, as shown, using a conventional securing device such as tibial fasteners, screws and washers, or staples. Alternatively, the ligament substitute 80 may be anchored from within the femur 15 and/or tibia 20 bone through use of a conventional securing device such as cross pins (such as those described in U.S. Pat. No. 7,032,599, col. 2, lines 42-62), or screws.

Referring to FIG. 10, there is shown a prosthetic knee implant 40 constructed in accordance with a preferred embodiment. The first end 81 of the ligament substitute 80 is disposed longitudinally through the femoral channel 46 and anchored to the exterior surface 19 of the femur 15, and the second end 82 of the ligament substitute 80 is disposed longitudinally through the tibial channel 64 and anchored to the exterior surface 22 of the tibia 20 with a self-anchoring umbrella anchor 90. In the preferred embodiment, the ligament substitute 80 is oriented generally parallel to the axis 33 of the natural anterior cruciate ligament 11.

A surgical kit useful in practicing the method of total knee arthroplasty of the present invention is anticipated by the inventor. Such a kit would include the components previously described above. More specifically, the kit is seen to have a femoral component 41 including a replacement medial condyle 42 and a replacement lateral condyle 43, a tibial component 60 including a surface portion 61 adapted to slidably engage the femoral component 41 upon flexion and extension of the femoral component 41, an anterior cruciate ligament substitute 80, and means to anchor the ligament substitute 80 to the femur 15 and tibia 20, such as staples, screws or self-anchoring umbrella anchors 90. The tibial component 60 further includes a center portion 62 that defines an aperture 63 through the tibial component 60 substantially at its center. The kit would further include at least one drill guide component (51) cooperatively shaped to engage the apertures (44) and (63) of the femoral and

tibial components

41 and 60.

As will be apparent to one skilled in the art, various modifications can be made within the scope of the aforesaid description. Such modifications being within the ability of one skilled in the art for a part of the present invention and are embraced by the claims below. For example, the inventor anticipates variations in the types of anchors used, the depth to which any ligament substitute end might be anchored inside bone, the degree and manner in which tension might be applied to a ligament substitute, and the placement of the apertures in the femoral and tibial components for drilling. The priority in the steps of anchoring the ligament ends, whether above on the femur or below on the tibia, may be varied in accordance with the surgeon's experience and the particular operating situation is also anticipated.

Claims

1. A method of total knee joint replacement in the leg of a mammal, comprising the steps of:

a. replacing at least a portion of the lower femur with a prosthetic joint component, said femoral component including a medial and lateral condyle and further including a recess between said condyles defining an access way into the lower femur;

b. replacing at least a portion of the upper tibia with a prosthetic joint component, said tibial component including a surface portion for receiving the surfaces of said femoral condyles and arranged for slidably supporting said same, said tibial component further including an aperture formed at its center;

c. engaging a drill alignment guide to said femoral component between said medial and lateral condyles and drilling a longitudinal tunnel through the femur and intersecting the medial aspect of the posterior lateral femoral condyle;

d. engaging a drill alignment guide to said tibial component and extending the femoral tunnel through said tibial aperture by drilling a longitudinal tunnel from the tibial anterior medial plateau of the tibia into said tibia and through said tibial aperture;

e. threading an anterior cruciate ligament substitute into said femoral tunnel and into said tibial tunnel and anchoring a first end of said ligament substitute to bone leaving a free end;

f. applying tension to said free end; and,

g. anchoring said free end to bone under tension such that said femur and said tibia are biased together.

2. The method as recited in claim 1, wherein said steps of drilling through said femur and tibia are accomplished such that the two tunnels form an axially aligned segment.

3. The method as recited in claim 2, wherein said tibial drilling step is done such that said tibial tunnel forms an angle of approximately 63 degrees with respect to medial joint line of the tibia.

4. The method as recited in claim 1, 2, or 3, wherein said femoral drilling step is done such that said femoral tunnel forms an angle of approximately 63 degrees with respect to the knee joint line bisecting said knee joint.

5. The method as recited in claim 1, 2, or 3, further comprising the steps of:

a. prior to said step of replacing said upper portion of said tibia with a tibial component, forming said aperture in the center of said tibial component by calculating the position of the longest path across the upper surface of said tibial component, calculating the shortest path across the upper surface of said tibial component, noting the intersection point of said shortest path and said longest path on said upper surface of said tibial component, and forming said aperture at said intersection point such that said aperture is positioned at the center of said upper surface.